Six Things to Look for in Medical Insurance Companies

Quality. The National Committee for Quality Assurance (NCQA) is a non-profit organization that evaluates and accredits insurance plans across the country. Medical insurance companies don’t have to submit their data to the NCQA, but those who do demonstrate that they care about quality. Generally, insurance companies that rate highly devote considerable effort in maintaining high quality medical and customer service standards.

Great customer care. Health insurance companies that meet or exceed national standards show their commitment to customer care. The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey is the gold standard for consumer satisfaction for medical insurance companies. The survey includes questions about member satisfaction with plans and with the health care, doctors and specialists. You may want to choose a medical insurance company that scores highly on standardized measures.

Tracks performance metrics. Companies that have a true commitment to their members not only talk about how they care, they regularly post results of their performance. Metrics such as average speed to answer calls, percent of abandoned calls, and accuracy and completeness of responses are tracked. Goals related to efficiently and accurately processing claims may also be posted.

Offers networks that include world-class doctors and specialists. Of course you want to make sure your favorite doctors are in the network, but you also need to know that if you require specialized treatment, you’re covered. Not every health insurance company has networks that include a wide range of specialists and leading medical centers.

Physicians, not a health plan, should decide what care you receive. Insurance companies should rely on physicians and other clinicians to make clinical decisions in regard to the appropriate and necessary care for its members.

Offers convenient wellness programs that include incentives. Most medical insurance companies offer some kind of wellness program. Some programs are just a lot of paperwork, and others are designed to offer real assistance to help encourage a healthy lifestyle. Look for a robust program that includes reimbursement for gym memberships and weight management programs, pregnancy and childbirth programs, health management programs and more. Some insurance companies will even reimburse you for buying produce straight from the farm!